Does type of health insurance affect health care use and assessments of care among the privately insured?

Objective. To inform the debate about managed care by examining how differe nt types of private insurance-indemnity insurance, PPOs, open model HMOs, a nd closed model HMOs-affect the use of health services and consumer assessm ents of care. Data Sources/Data Collection. The 1996-1997 Community Tracking Study Househ old Survey, a nationally representative telephone survey of households, and the Community Tracking Study Insurance Followback Survey, a supplement to the Household Survey, which asks insurance organizations to match household respondents to specific insurance products. The analysis sample includes 2 7,257 nonelderly individuals covered by private insurance. Study Design. Based on insurer reports, individuals are grouped into one of the four insurance product types. Measures of service use include ambulato ry visits, preventive care use, hospital use, surgeries, specialist use, an d whether there is a usual source of care. Consumer assessments of care inc lude unmet or delayed care needs, satisfaction with health care, ratings of the last physician visit, and trust in physicians. Estimates are adjusted to control for differences in individual characteristics and location. Principal Findings. As one moves from indemnity insurance to PPOs to open m odel HMOs to closed model HMOs, use of primary care increases modestly but use of specialists is reduced. Few differences are observed in other areas of service use, such as preventive care, hospital use, and surgeries. The l ikelihood of having unmet or delayed care does not vary by insurance type, but the reasons that underlie such access problems do vary: enrollees in mo re managed products are less likely to cite financial barriers to care but are more likely to perceive problems in provider access, convenience, and o rganizational factors. Consumer assessments of care-including satisfaction with care, ratings of the last physician visit, and trust in physicians-are generally lower under more managed products, particularly closed model HMO s. Conclusions. The type of insurance that people have-not just whether it is managed care but the type of managed care-affects their use of services and their assessments of the care they receive. Consumers and policymakers sho uld be reminded that managed care encompasses a variety of types of insuran ce products that have different effects and may require different policy re sponses.